Retroperitoneal Robot-Assisted Nephroureterectomy: Technical Description and Single Center Experience

Area of Science:

• Urology
• Robotic Surgery
• Oncology

Background:

• Robot-assisted radical nephroureterectomy (RANU) is gaining traction for upper tract urothelial carcinoma (UTUC).
• The retroperitoneal approach offers advantages by avoiding bowel mobilization.
• However, its adoption is limited by technical challenges and confined workspaces in robotic surgery.

Purpose of the Study:

• To describe a step-by-step retroperitoneal technique for RANU.
• To evaluate the perioperative outcomes of this approach in an initial single-center series.

Main Methods:

• Retrospective review of 46 patients undergoing intended fully robot-assisted retroperitoneal RANU.
• Exclusion of patients requiring laparoscopic assistance, radical cystectomy, or transperitoneal surgery.
• Assessment of patient characteristics, operative variables, deviations, and complications.

Main Results:

• Median operative time was 372 minutes, with low estimated blood loss (20 mL).
• Median postoperative hospital stay was 11 days.
• Unplanned deviations occurred in 8.8% of cases, and Clavien-Dindo grade ≥3 complications occurred in 8.8%.

Conclusions:

• Retroperitoneal RANU is feasible in selected UTUC patients.
• Preoperative assessment of anatomical complexity and surgical history is crucial.
• Identifying challenging cases can optimize the use of the retroperitoneal robotic approach.